Anesthetic Management of Intraoperative Carcinoid Crisis During Rigid Bronchoscopy in a Patient with Pulmonary Carcinoid Tumor and Bronchial Asthma

Abstract

Background: Pulmonary carcinoid tumors are rare, slow-growing neuroendocrine neoplasms. Though often indolent, they can precipitate carcinoid crisis during surgical manipulation, especially in central airway tumors.

Case Presentation: A 31-year-old female with bronchial asthma presented with progressive dyspnea. Imaging and bronchoscopy identified an endobronchial mass in the left main bronchus. Histopathology confirmed a typical carcinoid tumor. Despite normal chromogranin A and serotonin levels, persistent hypotension and tachycardia raised suspicion for subclinical vasoactive activity. The patient underwent rigid bronchoscopy under total intravenous anesthesia (TIVA) using propofol (Schneider model) and a supraglottic airway. During tumor manipulation, she developed acute bronchospasm, hypotension, and tachycardia suggestive of a carcinoid crisis. Immediate management with salbutamol, ketamine, and octreotide stabilized the patient, and resection was completed uneventfully.

Discussion: This case underscores the anesthetic challenges in managing pulmonary carcinoid tumors in asthmatic patients. TIVA minimized histamine release, and ketamine provided bronchodilation and cardiovascular support. Octreotide was crucial for aborting the crisis.

Conclusion: Anticipatory anesthetic planning, intraoperative vigilance, and early octreotide use are key in managing intraoperative carcinoid crisis during shared airway procedures.